Articles by David H Jacobs Ph.D

Why Do People Who Drink Excessively Need Personal Therapy?

Why do people have to be in therapy in order to stop drinking? You’d think that bad outcomes themselves would be reason enough to stop or at least lead to being careful and moderate. Why would a person need therapy in order to stop harming himself and getting himself in trouble? The simple answer is that people are doing the best they can in living’”doing the best they can to cope with the stress and challenges of life as they experience them. If a person persists in excessive drinking and getting into trouble, this must be because he cannot see how to cope with life without drinking. What we all primarily face in life as a practical matter is not how to maximize outcomes in the long run but how to get through the day. If this is kept in mind then excessive drinking that produces bad results will not seem so mysterious.

A puzzle and a clue can be found in excessive drinking or alcohol addiction itself. I have discussed excessive drinking with many people over the past ten years. It is commonly reported that after a few drinks on any given occasion there is no point to continued drinking in terms of feeling better. Indeed, the opposite occurs. Why then continue drinking, why drink copious amounts? Two answers seem to emerge from discussion: 1. there is a desire to avoid returning to the sober state, and 2. there is a desire to get far away from how one feels and thinks when sober. I admit that both answers are somewhat interpretive on my part in the sense that hardly anyone explicitly answers in either manner without some prompting and suggestion from me. Both answers point in the same direction, i.e., the sober state for people who drink excessively is difficult to bear and pleasant to escape from.

Excessive drinking is a problematic coping strategy in the long run because of its health and social consequences. This is a no-brainer – it only points once again to how undesireable excessive drinkers find continued sobriety, or even moderate escapes from sobriety. The only reason for this (usually, in the main, typically), that is the aversiveness of continued sobriety, is personal history, which most often means the experience of growing up in one’s family (I am deliberately overlooking sociological considerations, although from a large-scale epidemiological perspective they definitely matter. Overall, the more economic and social hardship the more reliance on psychoactive substances). Growing up in a noxious family environment does not invariably lead to substance abuse. There are after all many possible routes to achieve distraction from one’s history and feeling life, but noxious family history is a very significant risk factor (Google the Adverse Childhood Experience study conducted by Dr.Vincent Felitti at Kaiser Permanente in San Diego). I have become fond of saying there is a reason the formative years are called the formative years. If the formative years occur in a noxious environment there is a lot to try to remedy later in life.

A person whose main coping strategy is drinking is de facto insulated/estranged from social connectedness (spouses complain that excessive drinkers are married to the bottle). Relying on people is precisely what the excessive drinker is trying to avoid – it was clearly not a good idea growing up in her family. It may seem obvious once this is put into words, but the way out of drinking as the major way to cope with the challenges of living is to turn back to people and connectedness. The illusion/fantasy of self-sufficiency (relying on drinking, not people) must be forsaken. This is easier said than done for a person with a certain background. Individual therapy can be a bridge back to connectedness, which can be based on realistic trust in other people. Individual therapy can be a bridge because of what the therapist can offer: acceptance, empathy, understanding, interest, compassion etc. in more or less unsullied form, that is without the contaminants of judgment, demands, criticism, impatience, a personal agenda, and so on. The therapist is virtually the only person who can offer a relatively unsullied alliance because he is acting as a paid professional and is therefore not personally frustrated or disappointed by the client’s way of being and the client’s difficulties when it comes to change. This stands in contrast to the position of the client’s spouse, parents, employer, etc. No one else is really in an emotional position to serve as a bridge because everyone else involved with the client has a personal stake in the client changing. Obviously the client is not married to the therapist and relationships outside of therapy are inevitably complicated by the personal needs of the other party, but the point to repeat is that the person who has been committed to relying on drinking and not people as the way to cope with the challenges of life needs a bridge to the other side. This is a useful way to think about why the person who relies on excessive drinking needs individual therapy (assuming individual therapy conforms to the model I outlined above).

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